Endometrial Ablation
Considered minimally invasive surgery, endometrial ablation uses electrical energy, heat or cold to destroy the endometrium (the lining of the uterus), to minimize or even stop heavy bleeding. Bleeding is reduced or stopped in 70 to 80 percent of women who have received this form of treatment. The results aren't permanent, however, and the heavy bleeding may return. It is effective in those women who have no physical reasons (fibroids, for example) for their bleeding problems. This procedure may be considered an option only by women who have finished having children since a pregnancy any time after the procedure would be considered extremely high risk.

There are many methods of ablation approved by the U.S. Food and Drug Administration or in development.

Ablation can be performed under local anesthesia and it is usually done in the hospital on an outpatient basis.

Common postoperative side effects include nausea, vomiting and a vaginal discharge that can last from days to weeks. Complications are rare but may include blood loss requiring a transfusion, perforation of the uterus or unintended damage to other internal organs.³⁷

Myomectomy
If you hope to become pregnant or want to keep your uterus but need to consider fibroid treatment, you may be a candidate for myomectomy. This surgery cuts away fibroids without removing the uterus. However, it is major surgery, with all the attendant risks. It also tends to weaken the uterine wall; children born after the procedure may need to be delivered by cesarean section.

A myomectomy can be performed through a laparotomy, in which a surgeon enters the uterus through a small incision in the abdomen; or through a laparoscopy, in which the surgeon inserts a laparoscope through the navel and other instruments through very small incisions in the abdomen. Another method involves using a fiber optic tube called a hysteroscope and other small surgical instruments inserted into the uterus to cut out only those fibroids in the endometrial canal. A downside to myomectomy is that fibroids can recur, sometimes within a year of surgery.

Uterine Fibroid Embolization
Another minimally invasive procedure for treating fibroids, uterine fibroid embolization blocks the arteries that carry blood to the fibroids. It's performed under local anesthesia by a specially trained radiologist, called an interventional radiologist. The radiologist threads a catheter through a vein in your groin or leg, injecting tiny particles (embolic agents) into the uterine artery to block the arteries. Clots form around the particles, which are about the size of grains of sand and are usually made from plastic (polyvinyl alcohol) or gelatin sponge.

Risks associated with uterine fibroid embolization include infection, ovarian failure leading to early menopause, and expulsion of the fibroid from the uterus at a later date, requiring another procedure. Recent studies suggest that a significant number of patients will eventually need surgery for their fibroids. Women who undergo embolization may be able to become pregnant and carry a fetus to term, although there are no long-term studies on this question.²⁰

Remember, hysterectomy is not your only option for treating fibroids and other uterine conditions. Be sure to re-read "Uterine Conditions" for additional information on treatment options and discuss them with your health care professional.